这项研究由藤田健康大学资助 [2015100341 号赠款]。

1. 准备
注: 此处提出的测量方法采用了由十二个标记组成的简化标记集, 如下所述。整个测量过程, 包括准备工作, 可在20分钟内完成。本协议在实际临床设置中的可行性已在以前的研究中得到验证:13,14,15,16,17。
<ol><li>根据制造商的协议执行校准过程。</li>
	<li>指导病人穿得容易, 紧身 legwear, 并将彩色标记放在病人身上, 如下所述。<ol>
<li>将标记 (直径30毫米) 放在病人身体的以下点上: 两个 acromia, 臀部 (从股骨较大的大转子沿一条线连接每一个较大的大转子的方向 1/3), 膝盖 (上股骨每侧髁的前后直径中线, 踝关节 (侧足踝部), 脚趾 (第五跖骨头) 和髂嵴 (在每根髂嵴的位置上通过臀部的垂直线)。</li>
	</ol>
</li>
</ol>2. 测量
<ol><li>设置跑步机的速度和测量步态模式。<ol>
<li>指导病人进行10米步行测试。</li>
		<li>设置一个主观上舒适的步态速度。设置跑步机的速度, 从70% 的地面步态开始, 逐步提高速度, 在跑步机上找到舒适的步态速度。</li>
		<li>测量走路。对于单个会话, 它需要二十年代。如果需要比较不同的条件 (e. g. 步态速度、矫形器等), 请执行多个会话。在这种情况下, 病人休息1分钟之间的会话。 注: 虽然3DGA 系统的红外摄像机通常用于3DGA 研究, 一个基于视频的简化运动分析系统 (采样频率:60 赫兹;在本协议中,例如、Kinematracer) 用于缩短校准过程。</li>
	</ol>
</li>
</ol>3. 数据分析
<ol><li>
时间距离因素 注意: 时间距离参数是步态分析研究中常用的基本参数。根据脚趾和踝关节标记的轨迹, 自动确定足部初次接触和足部活动。<ol>
<li>为避免步进检测中出现错误, 有两位经验丰富的物理治疗师验证定时的准确性, 并在步骤定时出现错误时对其进行调整。</li>
		<li>从这些检测到的步骤计时, 计算以下内容:</li>
		<li>计算节奏 (步骤/分钟) = 60 x 2/SC (s)</li>
		<li>计算步长 (m) = GS (m/秒) x SC (s) + (踝关节标记从脚接触到同一侧足部接触的位移)</li>
		<li>计算步长 (m) = GS (米/秒) x (从一侧到脚接触的另一侧的脚接触的时间) + (一侧和另一侧脚接触的踝关节位置的平均差异)</li>
		<li>计算步长 (m) = 双姿态相位中踝关节标记间的平均横向距离</li>
		<li>计算双姿态的持续时间: 在步态周期中出现两次的双姿态相位的总和;另一侧的脚接触和随后的脚之间的时间。</li>
		<li>计算单姿态的持续时间: 在离脚和随后的脚接触之间的平均间隔在另一侧。 注: SC (阶梯循环): 平均时间从脚跟接触的一方到脚跟接触的同一方。** GS (步态速度)</li>
	</ol>
</li>
	<li>
利萨茹概述图片 (剪) 注: 洛普斯被设计成一个数字, 由主要关节上的标记关节轨迹组成, 目的是帮助了解康复患者的整体步态模式14 (见图 1)。<ol>
<li>在十个标记的坐标和水平 (x y) 的虚拟重心 (齿轮) 的轨道上生成洛普斯, 矢状 (y z) 和冠状 (z x) 平面 (x: 左/右, y: 前/后, z: 优越/劣势)。<ol>
<li>用软件或构造一个覆盖电子表格软件上所有标记的运动范围的散点图来绘制。通过假设每个正文段来计算虚拟齿轮, 如下所示: 树干, 0.66;大腿, 0.1;下大腿, 0.05;和脚, 0.02。随后, 计算齿轮作为线段的组成中心。</li>
		</ol>
</li>
		<li>在每个标记中, 为每个步态周期提取三个组件 (x、y 和 z) 的原始数据, 通过步态周期对其进行规范化, 并平均计算值。将虚拟齿轮的 x 和 y 分量的平均值设置为 0, 并将这些值用作标记的 x 和 y 分量的引用。</li>
	</ol>
</li>
	<li>
偏瘫步态异常步态指数的计算 注意: 一些常见的步态模式被称为中风后偏瘫步态的特点。这些包括髋部徒步旅行、circumduction 和主干18的横向移位。已开发出异常步态模式的指数, 以量化这些步态模式的范围13,16,17。到目前为止, 十异常步态指数 (髋关节徒步旅行, circumduction, 前脚接触, retropulsion 髋关节, 过度髋外旋转, 过度侧移躯干超过不受影响的一侧, 膝伸推力, 屈膝步态, 膝盖不足在摆动阶段和内侧鞭) 已报告的屈曲。表1显示了每个索引的公式。<ol>
<li>根据公式计算指数的原始值。例如, 计算髋部徒步旅行指数的原始值, 以说明摆动阶段髋关节标记的 z 坐标最大值与对侧髋关节标记的同时 z 坐标之间的差异, 为平均值改正双支撑阶段 z 坐标的左-右差。</li>
		<li>根据健康受试者的测量数据, 计算偏差评分 (t 评分)。计算标准分数如下: t = 50 + 10 x (X−µ)/δ (t: 偏差分数;X: 个人数据;µ: 健康主体的平均原始价值;δ: 标准偏差)。</li>
	</ol>
</li>
	<li>
脚趾间隙策略分析 注意: 摆动时脚趾间隙的策略在健康的受试者和下肢麻痹的患者之间有很大差异。在健康的课程中, 脚趾间隙是通过肢体缩短来实现的, 骨盆或躯干的运动最小。另一方面, 麻痹患者不能在相同的程度上缩短四肢。对于这些患者, 由此产生的补偿策略, 如骨盆倾斜或 circumduction 也影响脚趾清除19。在这一分析中, 脚趾间隙的高度分为两部分: 通过肢体缩短获得的垂直增益和补偿运动得到的, 这直接影响脚趾间隙。包括脚趾间隙的成分 (肢体缩短的垂直分量, 骨盆倾角, 髋关节绑架, 和跳马) 计算如下概述。<ol>
<li>计算从第五跖骨头的 z 坐标到脚趾间隙的总脚趾间隙。</li>
		<li>计算肢体缩短的垂直分量为髋部与第五跖骨之间距离变化的 z 坐标。</li>
		<li>通过总结三个子组件, 计算补偿运动的垂直分量, 如下所示。<ol>
<li>计算骨盆倾角的垂直分量, 作为髋关节标志物高度 (z 坐标) 的差异。</li>
			<li>计算髋部诱拐的垂直分量为髋部和第五跖骨头的距离和诱拐角。这反映出, 如果下肢长度没有改变, 足部将会移动的上升距离。</li>
			<li>在中位和中摆动20之间, 从对侧臀部 z 坐标的变化计算保险存储的垂直分量。</li>
		</ol>
</li>
	</ol>
</li>
</ol>

<ol>
	<li>Chen, G., Patten, C., Kothari, D. H., Zajac, F. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gait+differences+between+individuals+with+post-stroke+hemiparesis+and+non-disabled+controls+at+matched+speeds.">Gait differences between individuals with post-stroke hemiparesis and non-disabled controls at matched speeds.</a> Gait Posture. 22 (1), 51-56 (2005).</li><li>Stanhope, V. A., Knarr, B. A., Reisman, D. S., Higginson, J. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Frontal+plane+compensatory+strategies+associated+with+self-selected+walking+speed+in+individuals+post-stroke.">Frontal plane compensatory strategies associated with self-selected walking speed in individuals post-stroke.</a> Clin Biomech. 29 (5), 518-522 (2014).</li><li>Nadeau, S., Betschart, M., Bethoux, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gait+analysis+for+poststroke+rehabilitation:+the+relevance+of+biomechanical+analysis+and+the+impact+of+gait+speed.">Gait analysis for poststroke rehabilitation: the relevance of biomechanical analysis and the impact of gait speed.</a> Phys Med Rehabil Clin N Am. 24 (2), 265-276 (2013).</li><li>Balaban, B., Tok, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gait+disturbances+in+patients+with+stroke.">Gait disturbances in patients with stroke.</a> PM&amp; R. 6 (7), 635-642 (2014).</li><li>Roche, N., Pradon, D., Cosson, J., Robertson, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Categorization+of+gait+patterns+in+adults+with+cerebral+palsy:+a+clustering+approach.">Categorization of gait patterns in adults with cerebral palsy: a clustering approach.</a> Gait Posture. 39 (1), 235-240 (2014).</li><li>Baker, R., Esquenazi, A., Benedetti, M. G., Desloovere, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gait+analysis:+clinical+facts.">Gait analysis: clinical facts.</a> Eur J Phys Rehabil Med. 52 (4), 560-574 (2016).</li><li>Nadeau, S., Duclos, C., Bouyer, L., Richards, C. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Guiding+task-oriented+gait+training+after+stroke+or+spinal+cord+injury+by+means+of+a+biomechanical+gait+analysis.">Guiding task-oriented gait training after stroke or spinal cord injury by means of a biomechanical gait analysis.</a> Prog Brain Res. 192, 161-180 (2011).</li><li>Wikstr&#246;m, J., Georgoulas, G., Moutsopoulos, T., Seferiadis, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intelligent+data+analysis+of+instrumented+gait+data+in+stroke+patients-a+systematic+review.">Intelligent data analysis of instrumented gait data in stroke patients-a systematic review.</a> Comput Biol Med. 51, 61-72 (2014).</li><li>Davis, R. B., &#213;unpuu, S., Tyburski, D., Gage, J. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+gait+analysis+data+collection+and+reduction+technique.">A gait analysis data collection and reduction technique.</a> Hum Mov Sci. 10 (5), 575-587 (1991).</li><li>Cappozzo, A., Catani, F., Della Croce, U., Leardini, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Position+and+orientation+in+space+of+bones+during+movement:+anatomical+frame+definition+and+determination.">Position and orientation in space of bones during movement: anatomical frame definition and determination.</a> Clin Biomech. 10 (4), 171-178 (1995).</li><li>Leardini, A., Biagi, F., Merlo, A., Belvedere, C., Benedetti, M. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Multi-segment+trunk+kinematics+during+locomotion+and+elementary+exercises.">Multi-segment trunk kinematics during locomotion and elementary exercises.</a> Clin Biomech. 26 (6), 562-571 (2011).</li><li>Cimolin, V., Galli, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Summary+measures+for+clinical+gait+analysis:+a+literature+review.">Summary measures for clinical gait analysis: a literature review.</a> Gait posture. 39 (4), 1005-1010 (2014).</li><li>Itoh, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quantitative+assessment+of+circumduction,+hip+hiking,+and+forefoot+contact+gait+using+Lissajous+figures.">Quantitative assessment of circumduction, hip hiking, and forefoot contact gait using Lissajous figures.</a> Japanese J Compr Rehabil Sci. 3, 78-84 (2012).</li><li>Ohtsuka, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Application+of+Lissajous+overview+picture+in+treadmill+gait+analysis.">Application of Lissajous overview picture in treadmill gait analysis.</a> Japanese J Compr Rehabil Sci. 6, 33-42 (2015).</li><li>Mukaino, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Feasibility+of+a+Simplified,+Clinically+Oriented,+Three-dimensional+Gait+Analysis+System+for+the+Gait+Evaluation+of+Stroke+Patients.">Feasibility of a Simplified, Clinically Oriented, Three-dimensional Gait Analysis System for the Gait Evaluation of Stroke Patients.</a> Prog Rehabil Med. 1, (2016).</li><li>Tanikawa, H., Ohtsuka, K., Mukaino, M., Inagaki, K., Matsuda, F., Teranishi, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quantitative+assessment+of+retropulsion+of+the+hip,+excessive+hip+external+rotation,+and+excessive+lateral+shift+of+the+trunk+over+the+unaffected+side+in+hemiplegia+using+three-dimensional+treadmill+gait+analysis.">Quantitative assessment of retropulsion of the hip, excessive hip external rotation, and excessive lateral shift of the trunk over the unaffected side in hemiplegia using three-dimensional treadmill gait analysis.</a> Top Stroke Rehabil. 23 (5), 311-317 (2016).</li><li>Hishikawa, N., Tanikawa, H., Ohtsuka, K., Mukaino, M., Inagaki, K., Matsuda, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quantitative+assessment+of+knee+extensor+thrust,+flexed-knee+gait,+insufficient+knee+flexion+during+the+swing+phase,+and+medial+whip+in+hemiplegia+using+three-dimensional+treadmill+gait+analysis.">Quantitative assessment of knee extensor thrust, flexed-knee gait, insufficient knee flexion during the swing phase, and medial whip in hemiplegia using three-dimensional treadmill gait analysis.</a> Top Stroke Rehabil. , .</li><li>Perry, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+mechanics+of+walking+in+hemiplegia.">The mechanics of walking in hemiplegia.</a> Clin Orthop Relat Res. 63, 23-31 (1969).</li><li>Matsuda, F., Mukaino, M., Ohtsuka, K., Tanikawa, H., Tsuchiyama, K., Teranishi, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Biomechanical+factors+behind+toe+clearance+during+the+swing+phase+in+hemiparetic+patients.">Biomechanical factors behind toe clearance during the swing phase in hemiparetic patients.</a> Top Stroke Rehabil. 24 (3), 177-182 (2016).</li><li>Matsuda, F., Mukaino, M., Ohtsuka, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Analysis+of+strategies+used+by+hemiplegic+stroke+patients+to+achieve+toe+clearance.">Analysis of strategies used by hemiplegic stroke patients to achieve toe clearance.</a> Japanese J Compr Rehabil Sci. 7, 111-118 (2015).</li><li>Perry, J., Burnfield, J. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Gait analysis: normal and pathological function. , (1992).</li><li>Olney, S., Monga, T., Costigan, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanical+energy+of+walking+of+stroke+patients.">Mechanical energy of walking of stroke patients.</a> Arch Phys Med Rehabil. 67 (2), 92-98 (1986).</li></ol>

作者没有什么可透露的。

在本报告中, 提出了一种简化的3DGA 方法。该系统的设计用于日常的实践, 包括一个简化的测量方法和临床医生友好的结果表示。
以前的一些报告使用了 3DGA, 以前已经建立了人类步态的基本知识21。3DGA 有可能对康复诊所作出贡献, 例如, 改善对步态紊乱病理学的了解, 用于治疗规划, 或监测干预效果。然而, 在康复诊所使用3DGA 的情况仍然相当低。有几种可能的障碍, 使用3DGA 在临床设置。所需的时间可能是一个主要障碍, 因为基于研究的3DGA 通常需要大量的准备时间 (i. e), 用于校准系统并安装标记。另一个问题是, 结果解释可能具有挑战性。步态紊乱通常包括几个运动异常, 并了解分析所产生的各种图表需要经验。在临床可行性方面, 采用简化方法和直观数据演示的分析系统将会有所帮助。
完成现有分析方法所需的大量准备时间与追求高测量精度有关。然而, 步态障碍患者的运动速度是有限的, 在日常康复实践中, 我们可能不需要这种水平的准确性。在目前的方法中, 该协议是简化的, 可以在一个时间段内进行, 应足够短, 以便在日常康复实践中的可行性, 同时保持对运动障碍患者的评估要求13,15,16,17。
在目前的方法中, 结果表达方法符合临床要求。在康复诊所, 治疗师通常从评估整体步态模式开始。该方法旨在帮助临床医生使用代表性描述 (i. e) 直观地评估整体步态模式, 根据实际位置关系放置标记轨迹。本研究还以临床经验为基础, 研制了异常步态指数。制定指数来量化中风患者临床常见的异常步态模式, 并通过物理治疗师的临床观察证实所有指标的并发有效性13, 15,16。
该方法除了作为反映临床经验的客观评价方法外, 还将为新的康复策略的制定提供理想的帮助。对脚趾清除策略的分析超出了常规临床评价的范围, 有可能有助于规划有针对性的康复治疗。在所提出的方法和分析中, 临床医生提出两个康复目标;脚趾间隙的范围和达到此目的的补偿范围。因此, 增加脚趾间隙对安全行走是很重要的;但是, 减少补偿也可能提高步行效率22。在目前的方法, 临床医生将获得两组信息作为安全步行和步行效率的指标, 这可能有助于制定有针对性的康复战略, 以提高步行的安全和效率康复病人。
鉴于上述特点, 这种测量和分析方法可以为康复门诊使用 3DGA, 提供一种客观的方法来评估康复患者的步态模式。此外, 它还能更准确地估计干预效果, 而不是临床使用的普通尺度, 这有助于进一步提高康复领域的干预质量。
这项研究并非没有限制。考虑到标记数量的减少和采样率的较低, 与现有系统相比, 该系统的测量精度可能有限。这可能是一个关键的考虑, 当分析快速运动, 如体育专业人士。特别是在评估关节角度或关节运动时, 这种方法中使用的简化标记集可能不足以准确估计关节位置。因此, 对关节运动的分析, 如脑瘫手术的分析, 也可以用这个简化系统来限制。虽然该系统经临床评价证实, 但与金本位法相比, 该方法的心理测量性能尚未确定。今后的研究应进一步确认技术限制。
然而, 在步态障碍患者中, 运动速度有限, 表现差异明显, 与健康受试者比较。因此, 在日常实践中, 我们可能不需要现有方法所提供的精确度水平。此外, 在这个方法中, 结果作为一个平均步态模式, 在二十年代的测量周期, 这是比大多数传统的方法测量地面步态。该特性可提高测量的准确度和可靠性。
最后, 在本研究中, 介绍了一种简化直观的3DGA 方法。为方便使用3DGA 改善康复诊所的质量, 应制定临床可行的测量方法。这里介绍的临床医生友好的方法可能鼓励进一步发展临床可行的测量模型和实施3DGA 在每日康复诊所。

以往的研究表明, 三维步态分析 (3DGA) 在中风后的步态评估中是有用的1,2,3。研究与高质量的运动分析系统提供了大量的洞察人的步态模式, 不仅是那些健康的对象, 但也那些由于各种运动紊乱, 如中风或脑瘫4,5.了解病理学, 评估治疗计划前的病人, 或监测干预效果都可以用 3DGA6升级。此外, 最近的几项研究表明, 3DGA 为康复训练提供指南的可能性为7,8。
然而, 在每天的临床实践中使用3DGA 仍然是有限的。其中一个主要问题是耗时的过程。步态分析中常用的标记集9、10、11由30多个标记组成, 用于全身测量。这些标记集能够非常精确地估计肢体和躯干的运动。这有助于分析的准确性, 这通常是由在人行道周围的摄像头捕捉到的有限数量的步骤数据所做的。然而, 这需要一个耗时的准备和测量过程, 这妨碍了使用3DGA 在日常的临床实践。
在临床设置中使用3DGA 的另一个缺点是, 可能很难解释12提供的结果。3DGA 的结果通常显示在描述参数的图中, 如关节角和身体部位的位移。然而, 康复诊所的步态评估不仅包括评估身体部位的运动, 还涉及整体运动模式。后者只能通过评估这些参数之间的关系来理解, 这样做的难度使得临床医生更不愿意使用3DGA。
为解决这些问题, 促进3DGA 在康复门诊的使用, 我们提出了一种简便、直观的3DGA 测量方法。测量方法由以下几个部分组成: (1) 一个具有12个标记的简化标记集;(2) 测量跑步机上的病人;(3) 步态模式的直观整体图;(4) 通过临床观察验证步态异常指数;(5) 步态策略特征的可视化。本研究所示的议定书遵循该机构医德委员会的指导方针。

<table>
	<tbody>
		<tr>
			<td>KinemaTracer</td>
			<td>KisseiComtec Co., Ltd.</td>
			<td>KinemaTracer-6Cam</td>
			<td>A simple video-based 3D motion analysis system that consists of camera, workstation and softwares.</td>
		</tr>
	</tbody>
</table>

clinical-oriented three-dimensional gait analysis method for evaluating gait disorder

三维步态分析 (3DGA) 被证明是一个有用的临床工具, 以评估步态异常, 由于运动障碍。然而, 在实际诊所使用3DGA 仍然不常见。可能的原因可能包括耗时的测量过程和理解测量结果的困难, 这往往是使用大量的图表来提出的。在这里, 我们提出了一个临床医生友好的3DGA 方法开发, 以促进临床使用3DGA。这种方法包括简化的准备和测量过程, 可以在短时间内进行临床设置和直观的结果演示, 以促进临床医生对结果的理解。快速, 简化的测量程序是通过使用最小的标记和测量的病人在跑步机上实现的。为了促进临床医生的理解, 结果是根据临床医生的观点提出的数字。利萨茹概述图片 (), 显示所有标记的轨迹从一个整体的观点, 是用来促进直觉理解的步态模式。基于临床医生在步态评价中的观点和使用健康学科数据规范化的步态模式指数, 用于评价中风患者典型步态异常的程度。描述了脚趾间隙策略分析的图解, 描述了患者如何依靠正常的补偿策略来达到足趾间隙。这些方法可以促进3DGA 在临床环境中的实施, 并进一步鼓励从临床医生的角度制定测量策略。

本文的方法用于评价步态障碍患者。分析的结果显示在图 2、图 3和图 4中。这些数字显示的结果, 简化3DGA 的病人偏瘫和健康的控制。图 2显示了中风患者的完整步态模式的一个代表。在这个病人中, 观察到典型的步态模式, 如 circumduction、髋部抬高和躯干侧向运动。图 3是显示中风患者步态指数异常 (偏差评分) 的雷达图。circumduction 和髋部高度的标准化评分较高, 表明脑卒中患者的运动水平远高于健康人群。最后,图 4是描述中风患者脚趾间隙策略和年龄匹配的健康主题的图表。在健康的学科中, 脚趾间隙通常是通过肢体缩短来实现的, 而中风患者则主要通过骨盆倾角和跳马等补偿运动来实现。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/57063/57063fig1.jpg"> 图 1: 利萨茹概述图片 (切面) 由三个数字组成: (A)矢状平面、 (B)日冕平面和(C)水平平面。每个轨迹显示联合标记和假设重心的平均步态周期运动。<a href="//cloudflare.jove.com/files/ftp_upload/57063/57063fig1large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/57063/57063fig2.jpg"> 图 2: 有代表性中风患者的利萨茹概述图片: (a)矢状平面、 (B)日冕平面和(C)水平平面。增加树干运动 (白色箭头), 臀部徒步旅行 (黑箭头) 和 circumduction (灰色箭头) 从整体概要观察使用了。<a href="//cloudflare.jove.com/files/ftp_upload/57063/57063fig2large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/57063/57063fig3.jpg"> 图 3: 异常步态指数的雷达图.健康科目的平均评分设置为50。高标准分数代表高异常。<a href="//cloudflare.jove.com/files/ftp_upload/57063/57063fig3large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/57063/57063fig4.jpg"> 图 4: 显示中风患者与健康主题的脚趾间隙策略的图表.脚趾间隙是完全通过肢体缩短在健康的主题, 而补偿运动 (髋关节徒步旅行, 髋关节绑架, 和跳马) 也影响脚趾清除在中风患者。<a href="//cloudflare.jove.com/files/ftp_upload/57063/57063fig4large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody>
<tr>
<td>步态模式</td>
			<td colspan="2">公式</td>
		</tr>
<tr>
<td>徒步旅行</td>
			<td colspan="2">髋关节标记的 z 坐标最大值在摆动阶段和对侧髋关节标记的 z 坐标上的差异同时, 修正了在双中 Z 坐标的平均值左-右差。支持阶段</td>
		</tr>
<tr>
<td>Circumduction</td>
			<td colspan="2">在 25-75% 的姿态阶段, 踝关节标记的侧向 x 坐标在摆动阶段的 25-75% 和中间最 x 坐标之间的距离差异</td>
		</tr>
<tr>
<td>前脚接触</td>
			<td colspan="2">踝关节标记的 z 坐标与初始接触时脚趾标记的 z 坐标之间的距离, 减去踝关节标记和脚趾标记在站立期间的 z 坐标之间的距离差异</td>
		</tr>
<tr>
<td>Retropulsion 的臀部</td>
			<td colspan="2">单姿态阶段踝关节 y 坐标与髋关节 y 坐标的平均距离</td>
		</tr>
<tr>
<td>髋关节外旋转过度</td>
			<td colspan="2">摆动阶段踝关节 x 坐标与脚趾 x 坐标之间的平均距离</td>
		</tr>
<tr>
<td>过度的横向移位 树干在未受影响的边</td>
			<td colspan="2">之间的平均距离 (1) 双姿态相位部分两侧 acromions 的侧向 X 坐标, 受影响的腿位于受影响的腿后, 腿部的摆动阶段和 (2) 双侧踝关节间的平均 X 坐标, 即受影响的腿部位于未被感染的腿后的双重姿势阶段。</td>
		</tr>
<tr>
<td>膝伸推力</td>
			<td colspan="2">受影响腿单姿态阶段膝关节最大 Y 坐标速度与跑步机步态速度的差异</td>
		</tr>
<tr>
<td>屈膝步态</td>
			<td colspan="2">受影响腿部单姿态阶段的最大膝关节伸展角</td>
		</tr>
<tr>
<td>摆动阶段膝关节屈曲不足</td>
			<td colspan="2">摆动期最大膝关节屈曲角与健康受试者膝关节屈曲角的比较</td>
		</tr>
<tr>
<td>内侧鞭</td>
			<td colspan="2">在受影响的腿的姿势阶段, 踝关节 75-100% 的侧向 x 坐标与脚踝的内侧最 x 坐标之间的距离在 25-75% 之间</td>
		</tr>
<tr>
<td></td>
			<td colspan="2">X、Y 和 Z 坐标分别表示 lateromedial、anteroposteriol 和垂直。</td>
		</tr>
</tbody></table>表 1: 不正常步态模式的公式

Watch this Scientific Journal Video about Clinical-oriented Three-dimensional Gait Analysis Method for Evaluating Gait Disorder at JoVE.com

Clinical-oriented Three-dimensional Gait Analysis Method for Evaluating Gait Disorder

在本研究中, 本文提出了一种三维的基于临床的步态分析方法, 旨在在康复门诊进行。该方法由简化的测量方法和直观的数字组成, 有助于临床医生对结果的理解。

基于临床的三维步态分析方法评价步态障碍

Three-dimensional gait analysis (3DGA) is shown to be a useful clinical tool for the evaluation of gait abnormality due to movement disorders. However, ...

clinical-oriented-three-dimensional-gait-analysis-method-for

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JoVE Journal

Behavior

14.0K 次观看.  Fujita Health University. 在本研究中, 本文提出了一种三维的基于临床的步态分析方法, 旨在在康复门诊进行。该方法由简化的测量方法和直观的数字组成, 有助于临床医生对结果的理解。

视频: Clinical-oriented Three-dimensional Gait Analysis Method for Evaluating Gait Disorder

Contextual and Cued Fear Conditioning Test Using a Video Analyzing System in Mice

The contextual and cued fear conditioning test is one of the behavioral tests that assesses the ability of mice to learn and remember an association between environmental cues and aversive experiences. In this test, mice are placed into a conditioning chamber and are given parings of a conditioned stimulus (an auditory cue) and an aversive unconditioned stimulus (an electric footshock). After a delay time, the mice are exposed to the same conditioning chamber and a differently shaped chamber with presentation of the auditory cue. Freezing behavior during the test is measured as an index of fear memory. To analyze the behavior automatically, we have developed a video analyzing system using the ImageFZ application software program, which is available as a free download at http://www.mouse-phenotype.org/. Here, to show the details of our protocol, we demonstrate our procedure for the contextual and cued fear conditioning test in C57BL/6J mice using the ImageFZ system. In addition, we validated our protocol and the video analyzing system performance by comparing freezing time measured by the ImageFZ system or a photobeam-based computer measurement system with that scored by a human observer. As shown in our representative results, the data obtained by ImageFZ were similar to those analyzed by a human observer, indicating that the behavioral analysis using the ImageFZ system is highly reliable. The present movie article provides detailed information regarding the test procedures and will promote understanding of the experimental situation.

This article presents a protocol for a contextual and cued fear conditioning test using a video analyzing system to assess fear learning and memory in mice.

背景和线索恐惧制约试验小鼠中使用视频分析系统

The contextual and cued fear conditioning test is one of the behavioral tests that assesses the ability of mice to learn and remember an association ...

科研

行为学

Testing Sensory and Multisensory Function in Children with Autism Spectrum Disorder

In addition to impairments in social communication and the presence of restricted interests and repetitive behaviors, deficits in sensory processing are now recognized as a core symptom in autism spectrum disorder (ASD). Our ability to perceive and interact with the external world is rooted in sensory processing. For example, listening to a conversation entails processing the auditory cues coming from the speaker (speech content, prosody, syntax) as well as the associated visual information (facial expressions, gestures). Collectively, the &#8220;integration&#8221; of these multisensory (i.e., combined audiovisual) pieces of information results in better comprehension. Such multisensory integration has been shown to be strongly dependent upon the temporal relationship of the paired stimuli. Thus, stimuli that occur in close temporal proximity are highly likely to result in behavioral and perceptual benefits &#8211; gains believed to be reflective of the perceptual system&#39;s judgment of the likelihood that these two stimuli came from the same source. Changes in this temporal integration are expected to strongly alter perceptual processes, and are likely to diminish the ability to accurately perceive and interact with our world. Here, a battery of tasks designed to characterize various aspects of sensory and multisensory temporal processing in children with ASD is described. In addition to its utility in autism, this battery has great potential for characterizing changes in sensory function in other clinical populations, as well as being used to examine changes in these processes across the lifespan.

We describe how to implement a battery of behavioral tasks to examine the processing and integration of sensory stimuli in children with ASD. The goal is to characterize individual differences in temporal processing of simple auditory and visual stimuli and relate these to higher order perceptual skills like speech perception.

测试儿童的感官和多感官功能自闭症谱系障碍

In addition to impairments in social communication and the presence of restricted interests and repetitive behaviors, deficits in sensory processing are ...

A General Method for Evaluating Deep Brain Stimulation Effects on Intravenous Methamphetamine Self-Administration

Substance use disorders, particularly to methamphetamine, are devastating, relapsing diseases that disproportionally affect young people. There is a need for novel, effective and practical treatment strategies that are validated in animal models. Neuromodulation, including deep brain stimulation (DBS) therapy, refers to the use of electricity to influence pathological neuronal activity and has shown promise for psychiatric disorders, including drug dependence. DBS in clinical practice involves the continuous delivery of stimulation into brain structures using an implantable pacemaker-like system that is programmed externally by a physician to alleviate symptoms. This treatment will be limited in methamphetamine users due to challenging psychosocial situations. Electrical treatments that can be delivered intermittently, non-invasively and remotely from the drug-use setting will be more realistic. This article describes the delivery of intracranial electrical stimulation that is temporally and spatially separate from the drug-use environment for the treatment of IV methamphetamine dependence. Methamphetamine dependence is rapidly developed in rodents using an operant paradigm of intravenous (IV) self-administration that incorporates a period of extended access to drug and demonstrates both escalation of use and high motivation to obtain drug.

This article describes the delivery of intracranial electrical stimulation that is temporally and spatially separate from the drug-use environment for the treatment of IV methamphetamine dependence.

一般方法评估对静脉注射甲基苯丙胺的自我管理深部脑刺激的影响

Substance use disorders, particularly to methamphetamine, are devastating, relapsing diseases that disproportionally affect young people.  There is a need ...

A Method for Evaluating the Reinforcing Properties of Ethanol in Rats without Water Deprivation, Saccharin Fading or Extended Access Training

Operant oral self-administration methods are commonly used to study the reinforcing properties of ethanol in animals. However, the standard methods require saccharin/sucrose fading, water deprivation and/or extended training to initiate operant responding in rats. This paper describes a novel and efficient method to quickly initiate operant responding for ethanol that is convenient for experimenters and does not require water deprivation or saccharin/sucrose fading, thus eliminating the potential confound of using sweeteners in ethanol operant self-administration studies. With this method, Wistar rats typically acquire and maintain self-administration of a 20% ethanol solution in less than two weeks of training. Furthermore, blood ethanol concentrations and rewards are positively correlated for a 30 min self-administration session. Moreover, naltrexone, an FDA-approved medication for alcohol dependence that has been shown to suppress ethanol self-administration in rodents, dose-dependently decreases alcohol intake and motivation to consume alcohol for rats self-administering 20% ethanol, thus validating the use of this new method to study the reinforcing properties of alcohol in rats.

This protocol describes a novel and efficient method to quickly initiate operant responding for ethanol in rats that, contrary to standard methods, does not require water deprivation or saccharin/sucrose fading to initiate responding.

一种用于评价大鼠乙醇的补强性能没有禁水，糖精衰落或扩展访问训练方法

Operant oral self-administration methods are commonly used to study the reinforcing properties of ethanol in animals. However, the standard methods ...

Substantiating Appropriate Motion Capture Techniques for the Assessment of Nordic Walking Gait and Posture in Older Adults

Nordic walking (NW) has become a safe and simple form of exercise in recent years, and in studying this gait pattern, various data collection techniques have been employed, each with positives and negatives. The aim was to determine the effect of NW on older adult gait and posture and to determine optimal use of different data collection systems in both short and long duration analysis. Gait and posture during NW and normal walking were assessed in 17 healthy older adults (age: 69 &#177; 7.3). Participants performed two trials of 6 Minute Walk Tests (6MWT) (1 with poles (WP) and 1 without poles (NP)) and 6 trials of a 5m walk (3 WP and 3 NP). Motion was recorded using two systems, a 6-sensor accelerometry system and an 8-camera 3-dimensional motion capture system, in order to quantify spatial-temporal, kinematic, and kinetic parameters.
With both systems, participants demonstrated increased stride length and double support and decreased gait speed and cadence WP compared to NP (p &#60;0.05). Also, with motion capture, larger single support time was found WP (p &#60;0.05). With 3-D capture, smaller hip power generation and moments of force were found at heel contact and pre-swing as well as smaller knee power absorption at heel contact, pre-swing, and terminal swing WP compared to NP, when assessed over one cycle (p &#60;0.05). Also, WP yielded smaller moments of force at heel contact and terminal swing along with larger moments at mid-stance of a gait cycle (p &#60;0.05). No changes were found for posture.
NW seems appropriate for promoting a normal gait pattern in older adults. Three-dimensional motion capture should primarily be used during short duration gait analysis (i.e. single gait cycle), while accelerometry systems should be primarily employed in instances requiring longer duration analysis such as during the 6MWT.

The aim was to substantiate optimal use of data collection techniques for Nordic walking gait and posture analysis. Three-dimensional motion capture should be used during short duration analysis (i.e. single gait cycle), while accelerometry should be employed for longer duration analysis (i.e. repeated cycles) like a 6 Minute Walk Test.

充实适当的运动捕捉技术的越野行走步态中老年人的评估和姿势

Nordic walking (NW) has become a safe and simple form of exercise in recent years, and in studying this gait pattern, various data collection techniques ...

Using Gold-standard Gait Analysis Methods to Assess Experience Effects on Lower-limb Mechanics During Moderate High-heeled Jogging and Running

A limited number of studies have explored lower-limb biomechanics during high-heeled jogging and running, and most studies have failed to clarify the wearing experience of subjects. This protocol describes the differences in lower-limb kinematics and ground reaction force (GRF) between experienced wearers (EW) and inexperienced wearers (IEW) during moderate high-heeled jogging and running. A three-dimensional (3D) motion analysis system with a configured force platform was used to synchronously capture lower-limb joint movements and GRF. 36 young females volunteered to participate in this study and were asked about high-heeled shoe-wearing experience, including frequency, duration, heel types, and heel heights. Eleven who had the experience of 3 to 6 cm heels for a minimum of three days per week (6 h per day) for at least two years and eleven who wore high heels less than twice per month participated. Subjects performed jogging and running at comfortable low and high speeds, respectively, with the right foot completely stepping onto a force platform when passing by along a 10 m walkway. EW and IEW adopted different biomechanical adaptations while jogging and running. IEW exhibited a generally larger range of joint movement, while EW showed a dramatically larger loading rate of GRF during running. Hence, further studies on the lower-limb biomechanics of high-heeled gait should strictly control the wearing experience of the subjects.

This study investigated lower-limb kinematics and ground reaction force (GRF) during moderate high-heeled jogging and running. Subjects were divided into groups of experienced wearers and inexperienced wearers. A three-dimensional motion analysis system with a configured force platform captured lower-limb joint movements and GRF.

运用金本位步态分析法评估下肢慢跑和跑步时的低肢力学经验效应

A limited number of studies have explored lower-limb biomechanics during high-heeled jogging and running, and most studies have failed to clarify the ...

Use of a Psychophysiological Script-driven Imagery Experiment to Study Trauma-related Dissociation in Borderline Personality Disorder

This protocol offers a detailed description of a psychophysiological experiment using script-driven trauma-related imagery and standardized clinical instruments within a comparative design assessing physiological and psychopathological features of individuals with BPD. This method aims at studying the psychological and physiological effects of trauma-related dissociation. Since the psychodiagnostic classification of trauma-related disorders relies on the observation of evolutionarily determined responses to life-threat, an integrated assessment paradigm for the study of reactions to traumatic memories proposes a very appropriate methodological approach.
The employed script-driven imagery paradigm uses individual recall instructions to activate trauma-related memory networks and prompt associated emotional and physiological responses. These responses are measured by means of self-rating scales and physiological assessments. During the individual recall, participants are asked to vividly imagine traumatic and everyday experiences and other situations triggered by short personalized verbal scripts they authored beforehand together with the experimenters. A wide range of affective reactions and different physiological parameters can be measured. We used this paradigm to investigate dissociative states in BPD and to find physiological and affective correlates of dissociative states. Some of the participants were having severe traumatic antecedents.
To investigate different reaction patterns within the same diagnostic group, participants with different levels of traumatic histories, symptom severities, and co-morbidities should be included. By using short verbal scripts, the level of stress induced to participants is held as low as possible without affecting the validity of the object of investigation.

We present a protocol of personalized script-driven trauma-related imagery and clinical assessments within a comparison design for investigating peritraumatic dissociation (PD), psychophysiological reactions, i.e. heart rate (HR) and skin conductance (SC), and psychological features of often severely traumatized individuals with borderline personality disorder (BPD).

用心理生理学脚本驱动的图像实验研究边缘人格障碍的创伤相关离解

This protocol offers a detailed description of a psychophysiological experiment using script-driven trauma-related imagery and standardized clinical ...

Stress-Enhanced Fear Learning, a Robust Rodent Model of Post-Traumatic Stress Disorder

Fear behaviors are important for survival, but disproportionately high levels of fear can increase the vulnerability for developing psychiatric disorders such as post-traumatic stress disorder (PTSD). To understand the biological mechanisms of fear dysregulation in PTSD, it is important to start with a valid animal model of the disorder. This protocol describes the methodology required to conduct stress-enhanced fear learning (SEFL) experiments, a preclinical model of PTSD, in both rats and mice. SEFL was developed to recapitulate critical aspects of PTSD, including long-term sensitization of fear learning caused by an acute stressor. SEFL uses aspects of Pavlovian fear conditioning but produces a distinct and robust sensitized fear response far greater than normal conditional fear responses. The trauma procedure involves placing a rodent in a conditioning chamber and administering 15 unsignaled shocks randomly distributed over 90 minutes (for rat experiments; for mouse experiments, 10 unsignaled shocks randomly distributed over 60 minutes are used). On day 2, rodents are placed in a novel conditioning context where they receive a single shock; then, on day 3 they are placed back in the same context as on day 2 and tested for changes in freezing levels. Rodents that previously received the trauma display enhanced levels of freezing on the test day compared to those that received no shocks on the first day. Thus, with this model, a single highly stressful experience (the trauma) produces extreme fear of the stimuli associated with the traumatic event.

Here we describe the detailed methodology required to conduct stress-enhanced fear learning (SEFL) experiments, a preclinical model of post-traumatic stress disorder, in both rats and mice. The model utilizes aspects of Pavlovian fear conditioning and freezing as an index of enhanced fear in rodents.

压力增强恐惧学习--创伤后应激障碍的健壮啮齿动物模型

Fear behaviors are important for survival, but disproportionately high levels of fear can increase the vulnerability for developing psychiatric disorders ...

Paw-Print Analysis of Contrast-Enhanced Recordings (PrAnCER): A Low-Cost, Open-Access Automated Gait Analysis System for Assessing Motor Deficits

Gait analysis is used to quantify changes in motor function in many rodent models of disease. Despite the importance of assessing gait and motor function in many areas of research, the available commercial options have several limitations such as high cost and lack of accessible, open code. To address these issues, we developed PrAnCER, Paw-Print Analysis of Contrast-Enhanced Recordings, for automated quantification of gait. The contrast-enhanced recordings are produced by using a translucent floor that obscures objects not in contact with the surface, effectively isolating the rat&#8217;s paw prints as it walks. Using these videos, our simple software program reliably measures a variety of spatiotemporal gait parameters. To demonstrate that PrAnCER can accurately detect changes in motor function, we employed a haloperidol model of Parkinson&#8217;s disease (PD). We tested rats at two doses of haloperidol: high dose (0.30 mg/kg) and low dose (0.15 mg/kg). Haloperidol significantly increased stance duration and hind paw contact area in the low dose condition, as might be expected in a PD model. In the high dose condition, we found a similar increase in contact area but also an unexpected increase in stride length. With further research, we found that this increased stride length is consistent with the bracing-escape phenomenon commonly observed at higher doses of haloperidol. Thus, PrAnCER was able to detect both expected and unexpected changes in rodent gait patterns. Additionally, we confirmed that PrAnCER is consistent and accurate when compared with manual scoring of gait parameters.

Paw-Print Analysis of Contrast-Enhanced Recordings PrAnCER: A Low-Cost, Open-Access Automated Gait Analysis System for Assessing Motor Deficits

We describe a novel gait analysis system, Paw-Print Analysis of Contrast-Enhanced Recordings (PrAnCER), an open-access automated system for the quantification of gait characteristics in rats that utilizes a novel semitransparent floor to automatically quantify gait. This system was validated using the haloperidol model of Parkinson&#8217;s Disease.

对比度增强记录 (PrAnCER) 的爪打印分析:用于评估电机缺陷的低成本、开放访问自动步态分析系统

Gait analysis is used to quantify changes in motor function in many rodent models of disease. Despite the importance of assessing gait and motor function ...

3D Kinematic Gait Analysis for Preclinical Studies in Rodents

The utility of three-dimensional (3D) kinematic motion analysis systems is limited in rodents. Part of the reason for this inadequacy is the use of complex algorithms and mathematical modeling that accompany 3D data collection and analysis procedures. This work provides a simple, user-friendly, step-by-step detailed methodology for 3D kinematic gait analysis during treadmill locomotion in healthy and neurotraumatic rats using a six-camera motion capture system. Also provided are details on 1) calibration of the system in an experimental set-up customized for quadrupedal locomotion, 2) data collection for treadmill locomotion in adult rats using markers positioned on all four limbs, 3) options available for video tracking and processing, and 4) basic 3D kinematic data generation and visualization and quantification of data using the built-in data collection software. Finally, it is suggested that the utility of this motion capture system be expanded to studying a variety of motor behaviors before and after neurotrauma.

Presented here is a protocol to collect and analyze three-dimensional kinematics of quadrupedal locomotion in rodents for preclinical studies.

3D运动性步态分析,用于啮齿动物的临床前研究

The utility of three-dimensional (3D) kinematic motion analysis systems is limited in rodents. Part of the reason for this inadequacy is the use of ...